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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5280_Библиотеки_им_академика_М_И_Перельмана
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122 CORE VALUES IN FAMILY MEDICINE
there are no available data about people’s access to trained FPs, as there is no dif-
ferentiation between trained and untrained family doctors in the community.
BRIEF METHODS
We adopted three dierent methods to understand the interpretation and
conceptualisation of core family medicine values in the South Asian region
in the past and in the present.
Literature review of available resources in South Asia
A thorough literature review was conducted by searching all online material,
such as WONCA MO websites and journal articles on core values. In addi-
tion, the core values group members reached out to MOs to nd additional
resources unavailable on the internet.
Survey on family doctors’ views on core values
Using multiple methods for participant recruitment, an online questionnaire
was circulated among the primary care doctors in the region. e question-
naire was piloted before being sent to online forums and MOs. e questions
explored issues such as respondents’ insights on traditional core values, chal-
lenges, new and emerging core values in a changing world, and cultural and
socioeconomic relevance of core values. Incomplete responses were excluded,
and data were analyzed using SPSS soware using descriptive statistics.
Recording patient perspectives
A rapid literature review was conducted on patient perspectives on the val-
ues they expect from family doctors using the databases PubMed and Google
Scholar. Articles published within the past ten years were searched using key-
words ‘family physicians’, ‘family doctors’, ‘general practitioners’, ‘patient per-
spectives’, ‘community perspectives’, ‘public opinion’, ‘patient expectations’, and
‘patient satisfaction’. Duplicates found in two databases were removed, and stud-
ies not related to South Asia were excluded. Full texts of the remainder were
reviewed. Studies with a narrow scope (e.g., perspectives of home-based and pal-
liative patients only) were excluded. ere were nine papers in the nal review.
FINDINGS
Insights from existing literature
Family medicine is a specialty that is vital in providing healthcare to rural
and urban areas of South Asia, a region known for its distinct cultural back-
ground, economic challenges, and distinguishing healthcare needs. Although
EXPLORING CORE VALUES IN FAMILY MEDICINE IN SOUTH ASIA 123
family medicine is a specialty recognized globally, its modication in South
Asia echoes the unique goals and values of the region. From our review of
studies conducted in the region and MO statements, several core values are
shaped to suit this region’s socioeconomic context: patient-centred care,
accessibility, cultural sensitivity, continuity of care, and preventive health.
Patient-centred care actively involves patients in healthcare decision-
making by identifying their desires, beliefs, and preferences. In South Asia,
GPs/FPs frequently serve as primary healthcare providers, considering the
social, cultural, and traditional factors that impact their health behaviours.
is approach nurtures belief and adherence, particularly in areas where eco-
nomic constraints and cultural taboos aect healthcare access.
2
e social, economic, cultural, and geographical barriers make healthcare
access extremely challenging for people in this region. Family medicine, how-
ever, promotes accessible care by developing community-based models that
emphasize aordability and availability. ese strategies oen position FPs as
primary healthcare providers in outreach programmes targeting underprivi-
leged and rural communities. Hence, in areas with reduced access to special-
ists and advanced medical services, FPs may ensure that remote populations
receive basic and advanced care.
3
South Asia is one of the world’s most linguistically, culturally, and reli-
giously diverse regions. Cultural understanding is necessary for eective fam-
ily medicine in this setting since patients’ beliefs and customs signicantly
impact the healthcare decisions they make. In South Asia, FPs frequently
modify their treatment methods to suit religious and cultural customs, like
homeopathic or Ayurvedic treatments, which patients may prefer over con-
ventional medical treatment. For example, the community-based Vai dya
system, an ancient Indian tradition, referred to a local physician engaging
with the population. e Vaidya tradition continues as the FP who engages
with the community and provides cost-eective care with lifestyle changes,
dietary advice, and traditional healing techniques.
4
is strengthens the doc-
tor–patient relationship, as patients feel understood and valued in their cul-
tural context.
A fundamental principle of family medicine is continuity of care, espe-
cially crucial for managing rising numbers of non-communicable diseases,
including diabetes and cardiovascular disorders. Family medicine practices
are central to providing thorough, continuous treatment, developing endur-
ing connections which improve health outcomes.
5
FPs create a supportive
atmosphere that improves patients’ long-term health by oering individu-
alised care, health education, and regular follow-ups. ey frequently treat
entire families spanning generations. ey believe in a generalist approach,
which involves treating the entire body irrespective of the organ or disease.
6
124 CORE VALUES IN FAMILY MEDICINE
In an area where infectious diseases such as malaria, dengue fever, and
tuberculosis are common, preventive healthcare is crucial. To address these
diseases, South Asian FPs strongly emphasize preventative measures such
as immunization, health education, and cleanliness initiatives. Educating
patients on lifestyle changes is another aspect of this focus to help counter the
rise of non-communicable diseases in urban areas. In line with the compre-
hensive goal of family medicine, preventive health lowers healthcare expen-
ditures. It promotes healthier societies, aligning with the prime objective of
a holistic approach that every FP struggles to attain.
7
South Asian family medicine has developed to incorporate ideals that align
with the region’s needs. In addition to improving healthcare results, these
essential values tackle issues specic to South Asia, such as sociocultural
diversity, economic inequality, and a lack of adequate healthcare infrastruc-
ture. e mission of family medicine in this region is driven by fundamental
values such as patient-centred care, accessibility, cultural sensitivity, conti-
nuity, and preventative health, which guarantee that healthcare is practical,
comprehensive, and respectful for various groups.
Most South Asian MOs have publications on values and principles, and each
identies dierent core values but with many common features (Table9.2).
Analysis of survey
A total of 265 complete responses were analyzed. Maximum respondents
were from India (76; 29%) followed by Sri Lanka (56; 21%), Nepal (51; 19%),
Pakistan (46; 17%), Bangladesh (23; 9%), and Bhutan (13; 5%). One hundred
and sixty-four (62%) were trained FPs, 34 (13%) were academics, 32 (12%)
were trainees, 16 (6%) were untrained GPs, and 19 were (7%) non-GPs.
Traditional values
Respondents considered the following to be traditional core values: continu-
ity of care (28%), patient-centred care (26%), holistic care (23%), comprehensive
care (25%), coordinated care (16%), preventive care (15%), community-oriented
care (12%), rst-contact care (12%), compassionate care (11%), empathy (9%),
and family-oriented care (9%). ese core values were ranked highly by all the
respondents who were trained FPs (Table9.3). However, the understanding about
traditional core values was lower among trainees, untrained GPs, and non-GPs.
is demonstrates the importance of the family medicine postgraduate training
for better clarity and understanding about the nature of the discipline.
New innovative values
New core values in family medicine in South Asia also emerged from the
survey data. Respondents prioritized culturally sensitive patient-centred
care, integrating respect for diverse traditions, beliefs, and family dynamics.
ey saw health equity as a cornerstone, ensuring accessible, aordable care
EXPLORING CORE VALUES IN FAMILY MEDICINE IN SOUTH ASIA 125
TABLE9.2 Comparison of Core Values of Family Medicine/General Practice in South Asia
Core Value or
Principle
Principles of Family
Medicine by Riaz
Qureshi, Pakistan
(1998)
6
Values in Family
Medicine by College
of General
Practitioner Sri
Lanka (2002)
8
Principles of
Family Medicine
Academy of
Family
Physicians India
(2010)
9
General Practice
(Family Medicine)
in Nepal (2005)
10
Domains of
Family Medicine
in Bhutan
Curriculum
(2016)
11
Caring Caring attitude Gratitude Care of patients
in clinic, home,
and hospital
Care of patients in
clinic, home, and
hospital
Compassion Compassionate care Compassion Understanding
the context of
illness
Compassionate
care
Comprehensiveness
of care
Comprehensive care Advocacy Viewing the
practice as a
population at risk
Comprehensive
care
Professional and
ethical role
domain
Coordination of care Coordination of care Decency Commitment
towards patients
Coordinated care Organizational and
legal dimension
domain
Continuity of care Continuity of care Respect Sharing with
patients of same
habitat
Continuity of care
Preventive care Common problems
management
Loyalty Practice
preventive care
Viewing the
practice as a
population at risk
Preventive care
(
Continued )
126 CORE VALUES IN FAMILY MEDICINE
Core Value or
Principle
Principles of Family
Medicine by Riaz
Qureshi, Pakistan
(1998)
6
Values in Family
Medicine by College
of General
Practitioner Sri
Lanka (2002)
8
Principles of
Family Medicine
Academy of
Family
Physicians India
(2010)
9
General Practice
(Family Medicine)
in Nepal (2005)
10
Domains of
Family Medicine
in Bhutan
Curriculum
(2016)
11
Doctor–patient
relationship
Counselling and
communication skills
Empathy Recognition of
the subjective
aspects of
medicine
Positive doctor–
patient relationship
Communication
and patient–-
doctor relationship
Competency Clinical competence Competence Awareness of the
need to manage
resources
Applied
professional
knowledge and
skills
Applied
professional
knowledge and
skills
Cost-effectiveness Cost-effectiveness Cost effective care
Community-based
care
Community-based
care and research
Use of
community-wide
network of
supports
Community-based
care
Community health
and context of
general practice
TABLE9.2 (Continued)
EXPLORING CORE VALUES IN FAMILY MEDICINE IN SOUTH ASIA 127
TABLE9.3 Distribution of Respondents According to Their Opinion on Traditional Core Values
Core Value Trained FPs Academics Trainees Untrained GPs Non-GPs Total
N % N % N % N % N % N %
Continuity of care 75 28 13 5 17 6 2 1 7 3 11 4 43
Patient-centred care 70 26 15 6 14 5 4 2 8 3 111 42
Holistic care 62 23 9 30 15 6 3 1 9 3 98 37
Comprehensive care 67 25 16 6 11 4 0 0 2 1 96 36
Coordinated care 44 17 12 5 13 5 4 2 3 1 76 29
Preventive,
promotive...
39 15 9 3 7 3 1 0 5 2 61 23
Community-oriented
care
31 12 6 2 5 2 2 1 2 1 46 17
First-contact care 32 12 7 3 5 2 1 0 0 0 45 17
Compassionate care 29 111 4 2 4 2 2 1
4 2 43 16
Empathy 25 10 5 2 4 2 1 0 4 2 39 15
Family-oriented care 24 9 6 2 3 1 3 1 1 0 37 14
Cost-effective 25 9 3 1 3 1 3 1. 13 1 0 35 13
Ethics and
professionalism
20 8 2 1 5 2 3 1 4 1.51 34 13
128 CORE VALUES IN FAMILY MEDICINE
for underserved and marginalized populations. Community-oriented care
should focus on preventive health, leveraging local resources and traditional
practices to promote wellbeing.
e value of continuity of care can strengthen trust and long-term relation-
ships within families and communities. Additionally, individual autonomy
should balance with family involvement and collaborative decision-making,
respecting the region’s collective ethos. Embracing innovation, such as digital
health tools (telemedicine, articial intelligence [AI]), and addressing mental
health and chronic disease stigmas are also vital for modernizing care while
preserving cultural relevance.
Other values and principles to emerge included planetary healthcare (cli-
mate justice, environment sustainability), evidence-based decision-making,
equity and inclusivity, advocacy and leadership, patient empowerment and
shared decision-making, and cost-eectiveness.
Cultural aspects
In South Asia, cultural aspects deeply inuence the core values of family
medicine by emphasizing respect for traditions, family involvement, and
community orientation. Patient-centred care requires understanding spiri-
tual, social, and familial contexts, while long-term doctor–patient relation-
ships align with the cultural emphasis on trust and personal connections.
Addressing health disparities involves providing equitable, culturally com-
petent care, especially to marginalized populations. Ethical practice balances
individual autonomy with collective decision-making, reecting family and
community dynamics. Additionally, leveraging traditional practices for
health promotion and addressing stigmas around mental health and chronic
diseases are essential for eective, culturally sensitive healthcare delivery.
Responses received from the survey in priority order are:
• Personalized care, empathy, and respect – common core values could
cater to the cultural dierences, if used properly.
• Culturally sensitive (religious beliefs, sociocultural norms and values).
• Family involvement in care/family dynamics – family is the foundational
and functional unit of South Asian civilization.
• Collectivism/collective decision-making.
• Respect for elders and wisdom.
• Gratitude.
• Community solidarity.
• Hospitality and compassion.
• Spiritual and holistic healing.
• Emotional expression and support.
• Trust and relationship building.
EXPLORING CORE VALUES IN FAMILY MEDICINE IN SOUTH ASIA 129
• Integrating traditional/alternative medical practices.
• Care for vulnerable populations, equity, justice.
Patient perspectives on core values
Recognizing patients’ perspectives or expectations on the core values they
seek in FPs is critical for improving healthcare delivery. e result of our rapid
review found that patients’ perspectives of values in FPs among South Asians
focuses on compassion, social beliefs, communication, trust, and respect.
e doctor–patient relationship is very important, as that greatly inuences
healthcare interactions. We report the ndings from the nine papers in our
review.
Compassion is essential for quality healthcare and is fundamental to bridg-
ing cultural and ethnic dierences between patients and their healthcare pro-
viders. Singh et al. found that South Asian patients considered compassion
a key component of quality healthcare. e researchers recommended over-
coming language and cultural barriers to providing compassionate care to
patients.
12
Patient satisfaction is one of the cardinal facets of healthcare initiatives by
any nation. Providing high-quality services is indispensable for the success of
any service provider. Patients’ experiential values, both extrinsic and intrin-
sic factors, eventually impact how patients assess the quality of healthcare
they receive. Astudy in India by Dhal et al. reported that various intrinsic
qualities such as belief, trust, safety, convenience, and accessibility can be
adopted by an FP to increase patient-centred care.
13
Another study from India
emphasized the role of empathetic behaviour in eective healthcare delivery,
as it positively inuences the physician–patient relationship, leading to better
outcomes.
14
A study in Pakistan by Irshad et al. reported that most patients value
doctors who treat them with care, respect, and dignity. The physician
should be able to explain the condition and answer questions in ways that
patients can understand.
15
In Sri Lanka, quality of care is similar in both
public and private sectors, with patients perceiving better physicians to
be those who are competent, as well as having good communication and
interpersonal skills.
16
Bangladesh is a country dealing with cultural dierences, illiteracy, and
diverse religious and social norms, and hence, it has multifaceted scenarios of
patient–physician relationships. In a study on patients’ views on physicians’
communication skills in telemedicine, it was found that patients valued being
treated with respect, being allowed to talk without interruption, and hav-
ing physicians spend a sucient amount of time with them.
17
Another study
reports that physicians who respect the autonomy of the patients and provide
130 CORE VALUES IN FAMILY MEDICINE
ethical care as their moral basis were considered to have an ideal patient–phy-
sician relationship.
18
In Nepal, where most of the population resides in rural areas, primary
care physicians are important in providing access to basic healthcare needs.
A study by Stone found that recognition of community participation in
Nepal’s traditional medical system and respect for patients’ own ideas and
values would help improve patients’ engagement with healthcare.
19
Another
study reported that Nepalese patients prefer being treated by respectful,
friendly, knowledgeable physicians who give sucient consultation time and
practise preventive care. ey preferred the doctor to take charge and did not
want a shared decision-making approach.
20
In summary, South Asian patients broadly value FPs who practice with
compassion, empathy, competence, accessibility, and cultural sensitivity.
Although various challenges exist, such as resource limitations and systemic
ineciencies, FPs who prioritize trust-building, clear communication, and
ethical practices oen stand out optimistically in patient perspectives.
IMPLICATIONS AND APPLICATIONS
A statement on core values in family medicine in 2025 could be highly ben-
ecial for clinicians in South Asia, as it would provide a clear framework
for delivering patient-centred care in diverse and resource-constrained set-
tings. ese core values will reinforce the importance of long-term doctor–
patient relationships, which align with traditional trust-based practices in
South Asia. It will emphasize respect, empathy, and condentiality, helping
clinicians navigate complex cultural and ethical challenges. Treating patients
as individuals within their family and community contexts is a key aspect
of South Asian healthcare. Furthermore, it will encourage judicious use of
limited resources, emphasizing prevention, early diagnosis, and cost-eective
interventions. ere is an unmet need to reduce disparities and improve access
to care for marginalized populations, addressing a pressing regional chal-
lenge. Finally, core values will serve as a foundation for continuous learning
and reective practice for clinicians. Such a statement could unify clinicians
around shared goals, improve patient outcomes, and elevate the standards of
primary care in the region.
Implementing core values in family medicine in South Asia faces barri-
ers at multiple levels due to systemic, cultural, and individual challenges.
At the national level there are policy gaps. ere is a lack of robust policies
prioritizing primary healthcare and family medicine as a specialty. ere is
insucient government investment in healthcare infrastructure and train-
ing for FPs. ere is an existing rural–urban divide as an outcome of dis-
proportionate resource allocation, leaving rural areas underserved. ere is
poor integration of primary, secondary, and tertiary care, limiting continuity
EXPLORING CORE VALUES IN FAMILY MEDICINE IN SOUTH ASIA 131
of care. Furthermore, there is weak enforcement of ethical and professional
standards in medical practice. At the regional level there is signicant varia-
tion in resources, workforce distribution, and healthcare accessibility across
regions. ere are diverse cultural norms and beliefs that may conict with
standardized medical practices or core values.
Scarcity of family medicine training programmes in countries hinders
capacity-building. is gap has been used by several prot-oriented pro-
grammes, which do not focus on providing community need–based, country-
specic training in some countries. Frequent disruptions due to conict or
governance issues also aect healthcare delivery. At the individual level over-
burdened clinicians face time constraints, limiting their ability to focus on
holistic and preventive care. ere is a lack of awareness or formal education
in family medicine among GPs, and established practitioners may be reluc-
tant to adopt new frameworks or practices. High workload, limited support,
and challenging conditions undermine clinicians’ ability to adhere to core
values. Financial incentives oen favour specialty or procedural care over
comprehensive, patient-centred care. Core values in family medicine are oen
not implemented when planning undergraduate and postgraduate curricula
and research projects.
Addressing these barriers requires systemic reforms, robust advocacy,
investment in training and infrastructure, and cultural shis to integrate
family medicine values into practice eectively.
CONCLUSION
Family medicine and FPs play a crucial role in the healthcare systems of
South Asia, characterized by a unique set of core values that guide their prac-
tice. ese values are essential as they navigate the complexities and diverse
healthcare needs of this region, home to a signicant portion of the world’s
population. e core values and principles of family medicine in South Asia
include comprehensive care, continuity of care, patient-centredness, commu-
nity orientation, and cultural sensitivity. In family medicine, comprehensive
care addresses the broad spectrum of patients’ health issues.
FPs are oen the rst point of contact in the healthcare system, providing
a wide range of services from preventive care to treating acute and chronic
conditions. is comprehensive approach is crucial in a region where health-
care resources can be limited and access to specialists may be constrained.
FPs manage various health problems, ensuring patients receive holistic health-
care that considers physical, mental, and social factors. Continuity of care is
another cornerstone principle, emphasizing the ongoing relationship between
FPs and their patients. is is signicant in South Asia, where strong family
and community ties are prevalent. FPs oen serve multiple generations within
the same family, fostering trust and understanding over many years. is
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